Invasive Invasive Intraductal Papillary Mucinous Neoplasms Research Articles

Invasive IPMN and MCN: Same Organ, Sifferent Outcomes?

The efficacy of surgery for invasive mucinous neoplasms is unclear. We examined the natural history of invasive mucinous cystic neoplasms (MCN) and invasive intraductal papillary mucinous neoplasms (IPMN) in patients who underwent pancreatic resection. The Surveillance, Epidemiology, and End Results (SEER) database (1996-2006) was queried for cases of resected invasive MCN and IPMN. Demographics, tumor characteristics, and overall survival were examined using log-rank analysis and multivariate Cox regression model. Of 185 MCN cases and 641 IPMN cases, 73% and 48%, respectively, were women (P < 0.0001). Most (73%) IPMN were in the head of the pancreas; most (64%) MCN were in the tail/body (P < 0.0001). Lymph node metastasis was more common for IPMN than MCN (46% vs. 24%, P < 0.0001). Overall survival after resection was better for patients with stage I MCN vs. stage I IPMN (P = 0.0005), and it was better for patients with node-negative MCN vs. node-negative IPMN (P = 0.0061). There was no significant difference in survival of patients with stage IIA MCN vs. stage IIA IPMN (P = 0.5964), stage IIB MCN vs. stage IIB IPMN (P = 0.2262), or node-positive MCN vs. node-positive IPMN (P = 0.2263). Age older than 65 years (hazards ratio (HR) 1.71, P = 0.0046), high tumor grade (HR 2.68, P < 0.0001), higher T stage (HR 2.11, P < 0.0001), and IPMN histology (HR 1.90, P = 0.0040) predicted worse outcome in node-negative patients. Our findings suggest that survival is better after resection of invasive MCN versus invasive IPMN when disease is localized within the pancreas, but this difference disappears in the presence of nodal metastasis or extrapancreatic extension.

Invasive intraductal papillary mucinous neoplasm versus sporadic pancreatic adenocarcinoma

Although invasive intraductal papillary mucinous neoplasm (IPMN) of the pancreas is thought to be more indolent than sporadic pancreatic adenocarcinoma (PAC), the natural history remains poorly defined. The authors compared survival and identify prognostic factors after resection for invasive IPMN versus stage-matched PAC. The Surveillance, Epidemiology, and End Results database (1991-2005) was used to identify 729 patients with invasive IPMN and 8082 patients with PAC who underwent surgical resection. Patients with resected invasive IPMN experienced improved overall survival when compared with resected PAC (median survival, 21 vs 14 months; P<.001). Stratification by nodal status demonstrated no difference in survival among lymph node-positive patients; however, median survival of resected, lymph node-negative, invasive IPMN was significantly improved compared with lymph node-negative PAC (34 vs 18 months; P<.001). On multivariate analysis, PAC histology was an adverse predictor of overall survival (hazard ratio [HR], 1.31; 95% confidence interval [CI], 1.15-1.50) compared with invasive IPMN. For patients with invasive IPMN, positive lymph nodes (HR, 1.98; 95% CI, 1.50-2.60), high tumor grade (HR, 1.74; 95% CI, 1.31-2.31), tumor size>2 cm (HR, 1.50; 95% CI, 1.04-2.19), and age>66 years (HR, 1.33; 95% CI, 1.03-1.73) were adverse predictors of survival. Although lymph node-negative invasive IPMN showed improved survival after resection compared with lymph node-negative PAC, the natural history of lymph node-positive invasive IPMN mimicked that of lymph node-positive PAC. The authors also identified adverse predictors of survival in invasive IPMN to guide discussions regarding use of adjuvant therapies and prognosis after resection of invasive IPMN.

Invasive intraductal papillary‐mucinous neoplasm of the pancreas: Comparison with pancreatic ductal adenocarcinoma

The aim of this study was to clarify the clinicopathological differences between patients with invasive intraductal papillary-mucinous neoplasm (IPMN) of the pancreas and pancreatic ductal adenocarcinoma. The medical records of 16 patients with invasive IPMN and 106 patients with pancreatic ductal adenocarcinoma, who underwent surgical resection, were retrospectively reviewed, and the clinicopathological factors and survival were compared between the two groups. The presence of retroperitoneal tissue invasion, portal or splenic vein invasion, nodal involvement, and positive surgical margins were significantly lower in patients with invasive IPMN than in those with ductal adenocarcinoma (P < 0.05). The actuarial 5-year overall survival rates in patients with invasive IPMN and ductal carcinoma were 40% and 18%, respectively (P = 0.008). However, the actuarial 5-year survival rate of patients with invasive IPMN was only 27% for UICC stage II disease, although this was significantly higher than that of patients with UICC stage II ductal adenocarcinoma (P = 0.049). Invasive IPMN has a favorable prognosis compared with pancreatic ductal adenocarcinoma that is likely due to the less aggressive nature of the disease. However, the prognosis for cases of advanced invasive IPMN is not always favorable despite complete tumor resection.

Survival and Prognosis of Invasive Intraductal Papillary Mucinous Neoplasms of the Pancreas

Invasive intraductal papillary mucinous neoplasm (IPMN) of the pancreas is often considered to have a better prognosis than pancreatic ductal adenocarcinoma. The aim of this study was to evaluate and compare the prognosis and clinicopathologic features between 2 groups. Clinicopathologic features and long-term outcome of 32 patients with invasive IPMN were retrospectively evaluated and compared with those of 332 patients with pancreatic ductal adenocarcinoma. Asymptomatic patients were more frequently observed in the group of invasive IPMN than ductal adenocarcinoma (28% vs 11%, P = 0.013). The distribution of stages of invasive IPMN was as follows: stage I (n = 10, 31%), II (n = 8, 25%), III (n = 3, 9%), and IV (n = 11, 34%). Among 19 patients who underwent resection for invasive IPMN, 10 (53%), 1 (5%), 1 (5%), and 2 (11%) had T1 stage tumors and tumor with lymph node metastasis, lymphatic, and perineural invasions, respectively, which were significantly infrequently observed compared with those with ductal adenocarcinoma. The 5-year survival rate of invasive IPMN was 33.9% compared with 9% of ductal adenocarcinoma (P = 0.011). The difference in the mean survival rates between invasive IPMN and ductal adenocarcinoma in patients without metastasis was also significant but not in patients with metastasis. During the median follow-up period of 18.4 months, 3 patients (16%) had a recurrence after resection for invasive IPMN. Both the less aggressive pathological factors concerned with tumor invasiveness and early diagnosis of invasive IPMN contribute to higher survival rates of invasive IPMN than ductal adenocarcinoma. However, the prognosis of metastatic invasive IPMN is as poor as that of ductal adenocarcinoma.

Predictive Factors of Malignant or Invasive Intraductal Papillary-Mucinous Neoplasms of the Pancreas

The aim of this study was to identify useful preoperative diagnostic findings indicative of malignant or invasive intraductal papillary-mucinous neoplasms (IPMN) of the pancreas to determine an optimal operative procedure for IPMN. Sixty-two IPMNs, which consisted of 29 adenomas, 10 borderline tumors, 11 adenocarcinomas in situ, and invasive adenocarcinomas were reviewed from 1990 to 2003. Preoperative predictive factors of malignant or invasive IPMN were analyzed among 10 factors by univariate and multivariate analysis. Diameter of the main pancreatic duct (≧6 mm) and cytological examination of the pancreatic juice (the presence of malignant cells) were identified as independent predictive factors of malignant IPMN, and only cytological examination of the pancreatic juice (the presence of malignant cells) was identified as an independent predictor of invasive IPMN by multivariate analysis (P < 0.05). There was no recurrent disease in patients with adenoma and adenocarcinoma in situ, whereas recurrences occurred in 6 of 12 patients with invasive IPMN. Patient survival in noninvasive IPMN was significantly (P = 0.018) better than that in invasive IPMN (The overall 5-year survival rates were 87.2% and 49.2%, respectively). These results might be useful for selecting an optimal surgical procedure for IPMN.

Surgical Outcomes of Noninvasive and Minimally Invasive Intraductal Papillary-Mucinous Neoplasms of the Pancreas

Noninvasive and minimally invasive intraductal papillary-mucinous neoplasms (IPMNs) have a favorable surgical outcome. However, cases of recurrent noninvasive or minimally invasive IPMN are sometimes encountered, and the patterns of the recurrence of those tumors have not yet been fully clarified. In this study, we evaluated the surgical outcome of noninvasive and minimally invasive IPMNs, concentrating particularly on the pattern of recurrences. Twenty patients with noninvasive and minimally invasive IPMNs were assessed. Resected specimens were evaluated histopathologically with regard to the malignant nature of the tumors, the status of the surgical margin, and peripancreatic lymph node involvement. Cumulative overall survival rates and recurrence after surgery were assessed. Of the 20 patients, 13 had benign IPMNs, including adenomas (n = 10) and borderlines (n = 3), and 7 had malignant IPMNs, including carcinomas in situ (n = 4) and minimally invasive IPMNs (n = 3). Histopathologic examination confirmed the absence of tumor involvement in the resected lymph nodes and at the surgical margins. During the follow-up period, one patient with minimally invasive IPMN and one patient with noninvasive IPMN died of tumor recurrence in the peritoneum that was presumably caused by intraoperative manipulation. All of the patients with benign IPMNs survived, whereas the 10-year survival rate of the patients with malignant IPMNs was 67%. Surgical resection can offer a favorable outcome for noninvasive and minimally invasive IPMNs. Tumor recurrence was observed only in the peritoneal cavity. More careful perioperative management concerned with peritoneal recurrence should be emphasized for noninvasive and minimally invasive IPMNs.